Baucas stated, "My job is to write a bill that the Senate will pass." No, sir, that is not your job. You job as majority leader is to have the Republicans on the committee understand you have to write a bill the country desperately needs and the President will sign !!!!
...I'm just scanning what I've read to date to be sure I didn't miss something, like the provision allows for free health care for Dick Cheney...Oh, that's right, Cheney gets his health care free anyway.
WASHINGTON — Supporters of President Barack Obama's drive to remake health care are pushing back against a dire report from the insurance industry warning of hefty new costs for consumers from the latest legislation.
AARP Executive Vice President John Rother told reporters Monday that he doesn't think the report is "worth the paper it's written on." He said if anyone believes it, that's a problem....
Here it is. I knew there was something about 200% of the poverty level, which works out to be about $35,000, I forgot to mention.
Page 789, lines 1 through 18:
SEC. 1733. REQUIREMENT OF 12-MONTH CONTINUOUS COVERAGE UNDER CERTAIN CHIP PROGRAMS.
(a) IN GENERAL.—Section 2102(b) of the Social Security Act (42 U.S.C. 1397bb(b)) is amended by adding at the end the following new paragraph:
‘‘(6) REQUIREMENT FOR 12-MONTH CONTINUOUS ELIGIBILITY.—In the case of a State child health plan that provides child health assistance under this title through a means other than described in section 2101(a)(2), the plan shall provide for implementation under this title of the 12-month continuous eligibility option described in section 1902(e)(12) for targeted low-income children whose family income is below 200 percent of the poverty line.’’.
(b) EFFECTIVE DATE.—The amendment made by subsection (a) shall apply to determinations (and redeterminations) of eligibility made on or after January 1, 2010.
Page 801, lines 4 and 5 start a new section:
Subtitle F—Waste, Fraud, and Abuse
There is a lot of 'standard legislative' language here. As Senator Snow says, "Langauge that means what we want it to mean."
There are provisions to drop individual providers or entities if they are found in fraudulent status. Then it goes on to be specific that 'any' entity found to be eliminated from participation cannot receive monies through another entity, such as a health care clinic someone might own.
Page 807, lines 9 through 25 and page 808, lines 1 through 3:
SEC. 1757. MEDICAID AND CHIP EXCLUSION FROM PARTICIPATION RELATING TO CERTAIN OWNERSHIP, CONTROL, AND MANAGEMENT AFFILIATIONS.
(a) STATE PLAN REQUIREMENT.—Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by sections 1631(b)(1), 1703, and 1753, is fur15
ther amended—
(1) in paragraph (75), by striking at the end ‘‘and’’;
(2) in paragraph (76), by striking at the end the period and inserting ‘‘; and’’; and
(3) by inserting after paragraph (76) the following new paragraph:
‘‘(77) provide that the State agency described in paragraph (9) exclude, with respect to a period, any individual or entity from participation in the program under the State plan if such individual or entity owns, controls, or manages an entity that (or if such entity is owned, controlled, or managed by an individual or entity that)—
Those handling government payments and monies must be registered, Page 810, lines 11 through 13:
SEC. 1759. BILLING AGENTS, CLEARINGHOUSES, OR OTHER ALTERNATE PAYEES REQUIRED TO REGISTER UNDER MEDICAID.
There will be denial to payment if they are not registered, Page 811, lines 4 through 5 and 12 through 15:
(b) DENIAL OF PAYMENT.—Section 1903(i) of such Act (42 U.S.C. 1396b(i)), as amended by section 1753, is amended—
‘‘(26) with respect to any amount paid to a billing agent, clearinghouse, or other alternate payee that is not registered with the State and the Secretary as required under section 1902(a)(78).’’.
This is in regard to judicial review, page 812, lines 16 and 17 and page 813, lines 7 through 12:
SEC. 1760. DENIAL OF PAYMENTS FOR LITIGATION-RELATED MISCONDUCT.
...‘‘(B) to reimburse (or otherwise compensate) a managed care entity for payment of legal expenses associated with any action in which a court imposes sanctions on the managed care entity for litigation-related misconduct.’’.
What is a "Litigation Related Misconduct?" This is my take on it. Let's say the insured needs a kidney transplant. The insurance policy makes allowances for such procedures and practices provided the patient has a good chance of surviving the operation and meets any requirements the insurance company sees fit.
The obvious objection is that who is anyone in an insurance company to know what requirements should be to qualify as a kidney transplant patient. No one. The fact is the only person(s) qualified to order a transplant for a patient is an MD/Surgeon that has examined the patient and all necessary tests.
Also.
Who is to say whom will survive an operation? What is the sense in performing an operation if the patient is expected to die? Either way, if the patient has a better chance at living without the surgery, even a few days, no one is going to 'play God' and state that a transplant wouldn't save their life. Now, if a patient has multiple system involvement with an 'ejection fraction of 15% of his left heart ventrical' there might be a better candidate for the kidney because the patient probably won't make it to the operating table, yet alone survive the stress of organ transplant. As a matter of fact, someone with that poor a heart would probably never be a candidate for a kidney, however, they might be a candidate for a heart.
So, when push comes to shove and the insurance company is willing to litigate the payment for any reason and surgery or a procedure is not performed or a new medication isn't given that is called 'Delaying Patient Care.' For physicians and health care professionals that is an ethics issue and one taken seriously. Patients are supposed to be given relief from their symptoms in reasonable manner that benefits the patient.
But.
For insurance companies that provide coverage for health care they may see it as 'good prudent decision making' and not an ethics issue at all. So, if they decide there is no payment to be made and the patient 'seems' to meet all requirements according to their physician/surgeon, the insurance company is guilty of 'delaying patient care' and quite possibly cause the patient's death while the litigation is taking place.
That won't be allowed under this provision. Insurance companies will not be allowed to play with patient's lives and well being by delaying payment or approval through any litigation process.
Page 813, lines 16 and 19 and page 814, lines 4 through 14;
Subtitle G—Puerto Rico and the Territories
SEC. 1771. PUERTO RICO AND TERRITORIES.
(a) INCREASE IN CAP.—
‘‘(6) FISCAL YEARS 2011 THROUGH 2019.—The amounts otherwise determined under this subsection for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa for fiscal year 2011 and each succeeding fiscal year through fiscal year 2019 shall be increased by the percentage specified under section 1771(c) of the America’s Affordable Health Choices Act of 2009 for purposes of this paragraph of the amounts otherwise determined under this section (without regard to this paragraph).
So, USA territories are going to receive an increase in their payments as well. I guess everyone is going to be treated the same across the spectrum of the USA Health Care Insurance Reform Bill. Sounds right.
The next section is called "Technical Corrections". Page 917, lines 24 and 25 and page 918, lines 1 through 3:
(d) TECHNICAL CORRECTION TO SECTION 605 OF CHIPRA.—Section 605 of the Children’s Health Insurance Program Reauthorization Act of 2009 (Public Law 111–3) is amended by striking ‘‘legal residents’’ and inserting ‘‘lawfully residing in the United States’’.
I believe the 'operative word' is "lawfully."
I believe the word, 'residing' is a bit questionable.
Legally residing does not necessarily mean a resident. Or does it? Let's see, if Tony Blair buys a house in Palm Beach, Florida and resides there, he is lawfully residing, right? Or is he simply 'at' his home in a non-resident country and therefore is 'occupying' the house and not truly residing?
Hm?
I think that word, depending on the court, would be ambiguous. The language needs to be cleaned up a bit, and the words that should be used is "Resident" as noted by the Immigration Service.
John Lennon had that frustration. He owned property in New York and I believe from time to time he was made to go back to Great Britain to renew the 'Visa.' I think that would be the 'operative' issue in any court decision. Whether or not a person was residing would be overridden by their 'Visa/Immigration Status.' I think the language should be cleaned up a bit. Then again this is exclusively about children and we even bring Iraqi children here for treatment, so, the language would stand. We'll be getting kids from other places though to receive treatment in the USA. I think this language needs a separate provision with more specifics as to what child qualifies as 'legally residing.' I believe that is inappropriate.
The USA isn't going to be the children's haven for every country on the planet. We can easily be a 'resource' for children needing care they cannot receive elsewhere and perhaps without cost. But. That is a State Department provision. Yep. Any children not a 'legal resident' that requires care needs to be qualified by the State Department and they can have their own provision. I think that is the best way to do it, regardless the country of origin.
This Health Insurance Reform Bill is for the people of the USA. Granted we are a compassionate people that like to extend our ability to help to all people, especially children, however there is a limit to the monies that can be appropriated for children from other countries that come here for treatment. It isn't right and adds undo fiscal burden to the USA Treasury.
First, we take care of our own. I am sorry, but, there has to be a limit and a deterrent. A 'wide open' provision such as that would cause undo fiscal burden on the cost of this legislation and a victim for scrutiny. I don't want this bill to be viewed as a poorly conceived document and allowed to be trashed in the future.
The bill and its programs have to stand as examples of the ability of Democrats and the President to legislate in a 'balanced' measure. I think there needs to be care in how compassionate this legislation is to extend benefits to those that might be here legally but not residents of the USA. There is nothing saying anyone that comes to the USA can't receive care or treatment, but, to the extent this bill provides for them should be clear and concise and limited.
Page 819, lines 22 through 25:
SEC. 1782. EXTENSION OF QI PROGRAM.
(a) IN GENERAL.—Section 1902(a)(10)(E)(iv) of the Social Security Act (42 U.S.C. 1396b(a)(10)(E)(iv)) is amended—
Section 1902 of the SSI Act addresses subsidized health care. So any of the provisions within this section reflect changes to that subsidy.
QI is the Qualifying Individuals (QI) Program.
Page 819, lines 5 through 18:
(b) ELIMINATION OF FUNDING LIMITATION.—
(1) IN GENERAL.—Section 1933 of such Act (42 U.S.C. 1396u–3) is amended—
(A) in subsection (a), by striking ‘‘who are selected to receive such assistance under sub10
section (b)’’;
(B) by striking subsections (b), (c), (e), and (g);
(C) in subsection (d), by striking ‘‘furnished in a State’’ and all that follows and inserting ‘‘the Federal medical assistance percent age shall be equal to 100 percent.’’; and
(D) by redesignating subsections (d) and
(f) as subsections (b) and (c), respectively.
This particular 'section' of the Medicare Act has to do with Part B and the amount of reimbursement the States receive from the federal government to help pay for their programs to 'qualifying individuals.' This provision makes it easier on the States to pay for those individuals, because, the Federal government is going to provide total reimbursement.
Page 820 starts a very important section and will be read tomorrow. Lines 1 through 9:
TITLE VIII—REVENUE-RELATED PROVISIONS
SEC. 1801. DISCLOSURES TO FACILITATE IDENTIFICATION OF INDIVIDUALS LIKELY TO BE INELIGIBLE FOR THE LOW-INCOME ASSISTANCE UNDER THE MEDICARE PRESCRIPTION DRUG PROGRAM TO ASSIST SOCIAL SECURITY ADMINISTRATION’S OUTREACH TO ELIGIBLE INDIVIDUALS.
...until then.
